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2018 ; 7
(3
): 297-307
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Intensity-modulated radiotherapy for prostate cancer
#MMPMID30050791
Fischer-Valuck BW
; Rao YJ
; Michalski JM
Transl Androl Urol
2018[Jun]; 7
(3
): 297-307
PMID30050791
show ga
Radiation therapy (RT) is a curative treatment modality for localized prostate
cancer. Over the past two decades, advances in technology and imaging have
considerably changed RT in prostate cancer treatment. Treatment has evolved from
2-dimensional (2D) planning using X-ray fields based on pelvic bony landmarks to
3-dimensional (3D) conformal RT (CRT) which uses computed tomography (CT) based
planning. Despite improvements with 3D-CRT, dose distributions often remained
suboptimal with portions of the rectum and bladder receiving unacceptably high
doses. In more recent years, intensity-modulated radiation therapy (IMRT) has
become the standard of care to deliver external beam RT. IMRT uses multiple
radiation beams of different shapes and intensities delivered from a wide range
of angles to 'paint' the radiation dose onto the tumor. IMRT allows for a higher
dose of radiation to be delivered to the prostate while reducing dose to
surrounding organs. Multiple clinical trials have demonstrated improved cancer
outcomes with dose escalation, but toxicities using 3D-CRT and escalated doses
have been problematic. IMRT is a method to deliver dose escalated RT with more
conformal dose distributions than 3D-CRT and has been associated with improved
toxicity profiles. IMRT also appears to be the safest method to deliver
hypofractionated RT and pelvic lymph node radiation. The purpose of this review
is to summarize the technical aspects of IMRT planning and delivery, and to
review the literature supporting the use of IMRT for prostate cancer.